Female Pelvic Organ Prolapse
The uterus, bladder, and rectum are all located around the vaginal canal. Because of the way these organs are arranged, it is possible for them to herniate or bulge into the vaginal canal when supportive tissues in the pelvic region become weak. Such bulges are called prolapses.
Prolapse can lead to discomfort and heaviness in the vagina, difficulties using the toilet, or the unwanted leakage of urine, called urinary incontinence. When a prolapse is large, tissue may even be seen hanging outside the vagina.
Prolapse can be brought on by:
Although your symptoms may differ slightly, you may notice any of the following with a prolapse -
Why do Kegels?
Kegel exercises help to strengthen the muscles that support the vagina, uterus, bladder, and rectum. Greater support can be helpful in several ways:
How are Kegels done?
1. First, locate your pubococcygeus (PC) muscle in your pelvic floor.
2. Once you have found your PC muscle:
3. Remember to keep your abdominal muscles relaxed while you exercise your PC muscle. The best way to do this is to breathe normally while doing Kegels.
What is biofeedback therapy?
Biofeedback is a learning process where you become more aware of and more able to control your own body’s functioning. In urology and gynecology, biofeedback is typically used to help patients locate and strengthen their pelvic floor pubococcygeus (PC) muscle.
How does biofeedback work?
During biofeedback therapy, special measuring devices are placed in your vagina, rectum, or on your skin to monitor your pelvic floor. You are then asked to contract your PC muscle while watching the strength of each contraction on a computer screen. This interactive approach allows you to adjust each squeeze to make it stronger and more effective.
In the above example, the patient is learning to contract her pelvic floor muscles with more strength each time. She is also learning how to breathe properly and relax her abdominal muscles while exercising.
Pubococcygeus (PC) Muscle
This important muscular sheet helps anchor the urethra, vagina, anus, and rectum in their proper anatomic locations. When the PC muscle weakens, these structures are more likely to shift out of place and prolapses may occur in women or urinary incontinence may occur in either sex.
What is a pessary?
A pessary is a ring-like device that can be placed in the vagina to support structures such as the uterus or bladder. Some women find that wearing a pessary can help alleviate the discomfort caused by pelvic organ prolapse. They may also find that they have better bladder control and less urinary incontinence.
A urologist can almost always fit a patient with a pessary in one office visit. Pessaries come in various sizes, so it is important to find one that provides good support but also feels comfortable to the patient. Once a month, our patients at the University of Chicago Hospitals either remove their pessaries themselves or have their pessary removed in the office. The pessary is then thoroughly cleaned and reinserted.
The picture below shows a common type of ring pessary. Pessaries usually cause very few problems, but an increased chance for developing vaginal irritation or infection does exist.
So far, the oral estrogen in HRT has not been reliably shown to provide relief to those suffering from pelvic organ prolapse and urinary incontinence. For this reason, and because oral estrogen has so many potential side effects, we do not recommend starting HRT for the sole purpose of treating these conditions.
However, evidence has clearly demonstrated that estrogen can make skin thicker, softer, and smoother. It can also “plump up” the pelvic floor tissues and help women sustain their vaginal moistness. For this reason, it may be worthwhile to try a topical vaginal cream containing estrogen in the vaginal area.
The decision to have prolapse surgery is an important one that should be made only after receiving all the options and facts from your physician. Ultimately, it is up to you to decide when your quality of life could be improved with surgery.